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Pulmonary Function Tests (PFTs)
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Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
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Examining discordance in spirometry reference equations: A retrospective study.

Gerald S Zavorsky1,2, Sherif Elkinany2, Abdullah Alismail2,3

  • 1Department of Physiology and Membrane Biology, University of California, Davis, California, USA.

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|February 27, 2025
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Summary
This summary is machine-generated.

Race-based spirometry equations offer better model fit and reduce misclassification errors compared to race-neutral models. Omitting race increases false discovery and negative rates in diagnosing airway obstruction.

Keywords:
accuracyethnicitylung functionprediction equationspulmonaryracereference equations

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Area of Science:

  • Pulmonary Medicine
  • Medical Statistics
  • Clinical Diagnostics

Background:

  • Spirometry is crucial for diagnosing lung diseases.
  • Current spirometry prediction equations are debated regarding race adjustments.
  • Understanding the impact of race in these equations is vital for accurate diagnosis.

Purpose of the Study:

  • To evaluate discordance and model fit between race-predicted and race-neutral spirometry equations.
  • To assess the clinical implications of using race-neutral equations for diagnosing airway obstruction and restrictive patterns.

Main Methods:

  • Analysis of spirometry data from 9506 patients (White, Black, Hispanic).
  • Development of best-fit prediction equations using Bayesian Information Criterion (BIC).
  • Comparison of models with and without race as a covariate.

Main Results:

  • Including race as a covariate significantly improved model fit (BIC reduction ≥ 10 units).
  • Discordance in interpreting airway obstruction and restrictive patterns ranged from 4% to 13%.
  • Race-neutral equations led to higher false discovery rates (FDR) and false negative rates (FNR) for Black and Hispanic individuals.

Conclusions:

  • Removing race as a covariate in spirometry equations increases misclassification rates.
  • Race-specific equations are essential for accurate spirometry interpretation.
  • Clinical implications of discordance highlight the need for careful development of spirometry reference equations.